title: Auditing prescription practice using explicit criteria and computerized drug benefit claims data.
abstract: Bringing information on patterns of existing practice together with information on appropriate practice is an essential component of efforts to improve health care. In this study, computerized claims from a universal and comprehensive drug benefit plan for the elderly were brought together with explicit criteria for appropriate prescribing in the elderly in order to provide an estimate of the extent of potentially inappropriate prescribing in the covered population and the degree to which inappropriate prescribing was associated with defined physician characteristics. The analysis showed that 38% of elderly people who received antidepressants, 19% of those who received oral hypoglycemics, 18% of those who received sedative hypnotics and 13% of those who received non-steroidal anti-inflammatory drugs were defined as having received a potentially inappropriate drug. Older physicians and physicians without speciality certification were more likely to prescribe potentially inappropriate drugs. This analysis shows that criteria-based audits of drug claims databases can be used to provide an overview of prescribing problems at a population level and can reveal physician characteristics that may predict poor prescription practice. However, since neither explicit criteria nor claims databases can accurately capture the clinical details that ultimately define the appropriateness of care, audits of claims data should be linked to a more definitive measure of appropriateness and strategies designed to improve care.
authors.affiliation: Institute for Clinical Evaluative Sciences, North York, Ontario, Canada.
authors.forename: G M
authors.initials: GM
authors.lastname: Anderson
authors.forename: M H
authors.initials: MH
authors.lastname: Beers
authors.forename: K
authors.initials: K
authors.lastname: Kerluke
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000639:Amitriptyline / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002568:Certification; D002747:Chlorpropamide / Q000008:administration & dosage / Q000627:therapeutic use; D019992:Databases as Topic; D011307:Drug Prescriptions; D004363:Drug Utilization; D004501:Education, Medical; D005194:Family Practice / Q000193:education; D005544:Forecasting; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007356:Insurance, Pharmaceutical Services; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D013038:Specialization; D014600:Utilization Review
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D006993:Hypnotics and Sedatives; D007004:Hypoglycemic Agents; D000639:Amitriptyline; D002747:Chlorpropamide